title: Neglected role of hookah and opium in gastric carcinogenesis: a cohort study on risk factors and attributable fractions.
abstract: A recent study showed an association between hookah/opium use and gastric cancer but no study has investigated the relationship with gastric precancerous lesions. We examined the association between hookah/opium and gastric precancerous lesions and subsequent gastric cancer. In a population-based cohort study, 928 randomly selected, healthy, Helicobacter pylori-infected subjects in Ardabil Province, Iran, were followed for 10 years. The association between baseline precancerous lesions and lifestyle risk factors (including hookah/opium) was analyzed using logistic regression and presented as odds ratios (ORs) and 95% confidence intervals (CIs). We also calculated hazard ratios (HRs) and 95% CIs for the associations of lifestyle risk factors and endoscopic and histological parameters with incident gastric cancers using Cox regression models. Additionally, the proportion of cancers attributable to modifiable risk factors was calculated. During 9,096 person-years of follow-up, 36 new cases of gastric cancer were observed (incidence rate: 3.96/1,000 persons-years). Opium consumption was strongly associated with baseline antral (OR: 3.2; 95% CI: 1.2-9.1) and body intestinal metaplasia (OR: 7.3; 95% CI: 2.5-21.5). Opium (HR: 3.2; 95% CI: 1.4-7.7), hookah (HR: 3.4; 95% CI: 1.7-7.1) and cigarette use (HR: 3.2; 95% CI: 1.4-7.5), as well as high salt intake, family history of gastric cancer, gastric ulcer and histological atrophic gastritis and intestinal metaplasia of body were associated with higher risk of gastric cancer. The fraction of cancers attributable jointly to high salt, low fruit intake, smoking (including hookah) and opium was 93% (95% CI: 83-98). Hookah and opium use are risk factors for gastric cancer as well as for precancerous lesions. Hookah, opium, cigarette and high salt intake are important modifiable risk factors in this high-incidence gastric cancer area.
authors.affiliation: Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sadjadi
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Derakhshan
authors.forename: Abbas
authors.initials: A
authors.lastname: Yazdanbod
authors.forename: Majid
authors.initials: M
authors.lastname: Boreiri
authors.forename: Mahbubeh
authors.initials: M
authors.lastname: Parsaeian
authors.forename: Masoud
authors.initials: M
authors.lastname: Babaei
authors.forename: Masoomeh
authors.initials: M
authors.lastname: Alimohammadian
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Samadi
authors.forename: Arash
authors.initials: A
authors.lastname: Etemadi
authors.forename: Farhad
authors.initials: F
authors.lastname: Pourfarzi
authors.forename: Emad
authors.initials: E
authors.lastname: Ahmadi
authors.forename: Alireza
authors.initials: A
authors.lastname: Delavari
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
authors.forename: Masoud
authors.initials: M
authors.lastname: Sotoudeh
authors.forename: Arash
authors.initials: A
authors.lastname: Nikmanesh
authors.forename: Behrooz Z
authors.initials: BZ
authors.lastname: Alizadeh
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005757:Gastritis, Atrophic / Q000209:etiology; D016481:Helicobacter Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D008679:Metaplasia / Q000209:etiology; D009294:Narcotics / Q000008:administration & dosage*; D009892:Opium / Q000008:administration & dosage*; D011230:Precancerous Conditions / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000209:etiology*
chemical_list: D009294:Narcotics; D009892:Opium
keywords: Helicobacter pylori; gastric cancer; hookah; opium; precancerous lesions; smoking